比例法药敏试验检测乙胺丁醇耐药适合药物浓度的初步探讨

目的初步探讨比例法药敏试验检测乙胺丁醇(Ethambutol,EMB)耐药的适合浓度。方法分别采用0.8μg/mL、1.2μg/mL、1.6μg/mL、2.0μg/mL和2.4μg/mL五个浓度对26株敏感株和28株传统比例法药敏试验检测法判为敏感但embBMet306的突变株进行药物敏感性检测,比较不同药浓度、菌浓度耐药检出率,统计学分析采用SPSS15.0统计软件、χ2检验及Logarithmic模型拟和曲线等统计方法,P值标准采用0.05。结果26株敏感株5个浓度下耐药检出率均为0%,28株突变株在药物浓度为2.4μg/mL、2.0μg/mL、1.6μg/mL、1.2μg/mL和0.8μg/mL,菌浓度10-3mg/mL和10-5mg/mL的耐药检出率分别0、0、82.1%、89.3%、96.4%和0、0、25%、42.9%、53.6%。28株突变株在菌浓度分别为10-3mg/mL和10-5mg/mL,药物浓度为2.0μg/mL和1.6μg/mL间的耐药检出率差异均有统计学意义(P<0.05),但在1.6μg/mL和1.2μg/mL间的耐药检出率差异均无统计学意义(P>0.05)。因此,1.6μg/mL耐药检出率较高。Logarithmic模型曲线拟和,决定系数R2=0.774,拟和方程为y=0.923+(-0.974)lnx,模型具有显著性意义(P=0.000),证实所选择的本浓度梯度试验的耐药性检出率符合实际情况。结论传统比例法药敏试验,2.0μg/mL的EMB浓度偏高,1.6μg/mL确能提高耐药检出率,建议可在1.6μg/mL至2.0μg/mL间结合实验室和临床研究,确定能反映真实耐药水平的最佳药物浓度。     

下呼吸道真菌感染的临床特点及其药物敏感性分析

目的 了解本院呼吸科患者下呼吸道真菌感染的特点和对抗真菌药物的敏感性.方法 采用法国Chron G A念珠菌显色培养基及生物梅里埃API 20 C AUX分离鉴定菌株,用K-B法进行药敏试验.结果 共分离真菌151株,以白色念珠菌最常见(93株,占61.6%),其次为热带念珠菌(30株,占19.9 %),光滑念珠菌(19株)占12.6%,近平滑念珠菌(3株)占2.0 % ,烟曲霉菌(2株)占1.3%,其他念珠菌(4株)占2.6% .5种抗真菌药物中,制霉菌素、两性霉素B的敏感性最高,唑类药物耐药率较高.结论 下呼吸道真菌临床分离率较高,且不同菌种间药物敏感性存在差异,应加强对真菌的病原学及药物敏感性检测,以指导临床合理用药.     

微量稀释法测定致病酵母对氟康唑敏感性

测定ＭＩＣ是估计抗真菌药物敏感性和决定治疗方案的有效方法。我们用微量稀释法测定了８０株念珠菌和２０株新型隐球菌对三唑类抗真菌药氟康唑的敏感性。结果发现白念珠菌４０株敏感（７６．９２％），７株耐药，５株中介。克柔念珠菌几乎全部耐药，光滑念珠菌及热带念珠菌多数非敏感。新型隐球菌ＭＩＣ均值高于念球菌属。来自阴道分泌物的白念珠菌其耐药频率高于其它来源的菌株。电泳核型Ⅱ型菌株氟康唑非敏感株显著多于Ⅰ型菌株。这些结果表明临床进行抗真菌治疗及监测时测定药物敏感性及菌种鉴定是十分重要的。     

AIDS病人真菌菌种分离鉴定及体外抗真菌药敏分析

目的了解新疆地区艾滋病(AIDS)病人真菌感染的菌种分布和优势菌株,并检测AIDS病人病原真菌对不同抗真菌药物的体外敏感性,为临床早期诊断及合理用药提供科学依据,并发现该地区的耐药情况。方法分别取AIDS病人口咽、呼吸道、消化道及泌尿、生殖道的标本,采用常规方法做真菌培养,用科玛嘉显色培养基进行鉴定,药敏试验采用ATBTMFUNGUS3试剂盒测定50株分离酵母菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑的体外敏感性。结果100株分离菌株中,念珠菌属为97株,其他菌属3株;其中白念珠菌85株,克柔念珠菌6株,热带念珠菌2株,光滑念珠菌1株。曲霉菌属2株,分别为烟曲霉和土曲霉;接合菌属1株,为根霉。结论新疆地区AIDS病人真菌感染仍以白念珠菌为优势菌种,并有罕见菌种出现。抗真菌药物以5-氟胞嘧啶、两性霉素B敏感性较高,而唑类存在不同程度的耐药。     

性病门诊患者分离的酵母菌对氟康唑和伊曲康唑的敏感性研究

目的了解性病门诊中外阴阴道念珠菌病(VVC)患者分离的酵母菌,在体外对伊曲康唑(IT)、氟康唑(FL)的敏感性。方法用E-test抗真菌药敏试条在体外检测IT、FL对酵母菌的MIC值,判定敏感性。结果237例阴道分泌物标本中培养阳性168例,分离出白念珠菌153株(91.07%),其中对IT敏感129株(84.31%),中敏和耐药均12株(7.84%);对FL敏感150株(98.04%),中敏1株(0.65%),耐药2株(1.31%)。光滑念珠菌9例(5.36%),其中对IT敏感2株(22.22%),耐药7株(77.78%);对FL敏感6株(66.67%)、中敏1株(11.11%)、耐药2株(22.22%)。近平滑念珠菌1株(0.60%),对IT和FL均敏感。克柔氏念珠菌1株(0.60%),对IT和FL均耐药。热带念珠菌2株(1.19%),1株对IT耐药,2株对FL均敏感。清酒念珠菌2例(1.19%),对IT、FL均敏感。结论白念珠菌仍然是VVC的主要致病菌,白念珠菌对IT、FL存在不同程度的耐药。E-test法检测酵母菌对IT、FL的敏感性具有操作简便、快速的特点,为临床选择抗真菌药物具有一定的意义。     

氟康唑联合氟胞嘧啶治疗隐球菌性脑膜炎10年临床分析

目的 探讨氟康唑(FCZ)联合氟胞嘧啶(5-FC)治疗非AIDS相关隐球菌性脑膜炎的临床疗效.方法 回顾性分析52例非AIDS相关隐球菌性脑膜炎患者经两性霉素B(AmB)+ 5-FC治疗(32例)与FCZ+ 5-FC治疗(20例)的临床特点、疗效和转归,组间比较采用t检验和卡方检验.结果 AmB联合5-FC组与FCZ联合5-FC组治疗后的颅内压分别为(221.9±76.2)和(213.4±99.2) mm H2O(1 mm H2O=0.0098 kPa),脑脊液隐球菌数分别为(351±1180)/mL和(508±943)/mL,脑脊液蛋白含量分别为(0.754±0.726)g/L和(0.649±0.308)g/L,脑脊液白细胞数分别为(16±25)×106/L和(28±32)×106/L,两组上述指标比较,差异均无统计学意义(t=0.302,t=-0.473,t=0.578,t=-1.348,均P＞0.05).AmB联合5-FC组治愈率为59.38％(19/32),好转率为6.25％(2/32),未愈或病死率为34.38％(11/32);FCZ联合5-FC组治愈率为35.00％(7/20),好转率为25.00％(5/20),未愈或病死率为40.00％ (8/20),两组治愈率、未愈或病死率比较,差异无统计学意义(x2=2.925,x2=0.168;均P＞0.05).结论 FCZ联合5-FC治疗对隐球菌性脑膜炎亦有较好的疗效.     

五种抗深部真菌药物对烟曲霉体外抗菌活性的实验研究

目的 测定五种抗深部真菌药物对烟曲霉体外抗菌活性,为临床治疗侵袭性烟曲霉感染提供理论依据.方法 应用美国临床实验室标准化协会(CLSI)的微量液基稀释法 M38-A方案,测定烟曲霉临床株对伊曲康唑(ICZ)、两性霉素B(AmB)、伏立康唑(VRC)、卡泊芬净(CBF)、 氟康唑(FCZ)的敏感性.结果 MIC几何均数VRC为 0.29 μg/ml、CBF为0.45 μg /ml、ICZ为0.52 μg /ml、AmB为0.55 μg /ml、FCZ为62.58 μg /ml.结论 VRC、CBF、ICZ、AmB均有很强的抗烟曲霉作用,FCZ对烟曲霉均耐药.     

343株致病性念珠菌的基因鉴定及药物敏感性检测

目的了解本地区常见致病性念珠菌的基因类型及其药物敏感性。方法采用PCR及ATB FUNGUS3酵母菌样药敏试剂,检测临床分离的343株念珠菌的内部转录问题(ITS)和25 rDNAⅠ型内含子序列及其对常用抗真菌药物敏感性。结果 343株致病性念珠菌的ITS序列鉴定以白假丝酵母菌检出率最高(61.2%),其他依次分别为光滑假丝酵母菌(13.1%)和热带假丝酵母菌(8.4%);210株白假丝酵母菌25S rDNAⅠ型内含子基因鉴定为A型115株(54.8%)、B型58株(27.6%)和C型37株(17.6%),光滑假丝酵母菌与热带假丝酵母菌25S rDNA序列不存在Ⅰ型内含子;白假丝酵母菌的5-氟胞嘧啶(5-FC)和两性霉素B(AMB)敏感率大于90%,唑类药物敏感率在17.1%～23.9%且存在交叉耐药。结论本地区临床分离的致病性念珠菌以白假丝酵母菌及其基因A型最常见,检测ITS序列和25S rDNAⅠ型内含子序列有助于致病性念珠菌的快速鉴定;白假丝酵母菌对唑类药物的高耐药性以及交叉耐药性是造成真菌感染患者临床治疗困难的一个重要因素。     

念珠菌感染的菌种及耐药性分析

目的分析念珠菌属感染的菌种及耐药性。方法对321株念珠菌采用显色培养法及ATBTM FUN-GUS3真菌药敏试验板进行菌种鉴定和药敏试验。结果检出白色念珠菌192株,非白色念珠菌120株（主要为热带念珠菌、光滑念珠菌和克柔念珠菌）;念珠菌主要来自痰液标本,其余依次为尿液、粪便、分泌物、血液及其他标本。白色念珠菌对各种抗真菌药物耐药率较低;非白色念珠菌对氟康唑、伊曲康唑表现出不同程度的耐药,其中热带念珠菌、光滑念珠菌对5-氟胞嘧啶、两性霉素B耐药率较低,克柔念珠菌对氟康唑耐药率达100％,对伊曲康唑、5氟胞嘧啶的耐药率亦高于50％。结论临床真菌感染仍以白色念珠菌为主,非白色念珠菌感染呈上升趋势;不同念珠菌对常用抗真菌药物耐药性存在差异,白色念珠菌对抗真菌药物的耐药性低于非白色念珠菌。     

两年间临床分离念珠菌耐药情况分析

目的 了解我院住院患者临床分离的念珠菌分布及耐药现状.方法 收集近两年我院临床分离的念珠菌,测定常用抗真菌药物的敏感性.结果 两年内分别分离出念珠菌585株和1030株,分离率分别为11.76%和16.21%.白色念珠菌是最常见的分离菌,但热带念珠菌分离率上升.受检药物均有较高的抗菌活性,仅克柔念珠菌对氟康唑的耐药率分别为66.7%和77.1%,剂量依赖性敏感的比例分别为16.7%和20.0%.结论 白色念珠菌仍是分离出最常见的念珠菌,其次为热带念珠菌,建议白色念珠菌和热带念珠菌感染时使用氟康唑,克柔念珠菌感染者应用伊曲康唑.     

Isolation rate and antifungal drug susceptibility of yeast like fungi isolated from blood or vascular catheter

Increased resistance of strains to antifungal drugs has gained increasing attention. We studied the status of fungal isolation from blood and vascular catheters at Juntendo University Hospital from 1994 to 2002. The major fungi isolated were Candida albicans, Candida parapsilosis, Candida glabrata and Candida trophicalis, or 86% yeast-like fungi. Isolation of these fungi from vascular catheters is increasing. The effectiveness of 6 anti-fungal agents against 116 yeast-like fungi was measured by microdilution. In antifungal activity of micafungin (MCFG), MIC90, was < or = 0.03 g/mL for C. albicans, C. glabrata and C. tropicalis. MCFG showed the strongest antifungal activity among the drugs tested for above Candida spp.. Five of 37 strains of C. albicans were resistant to fluconazole (FLCZ) showing MIC > or =64 g/mL. These strains were also resistant to itraconazole (ITCZ) but MICs of MGFG, flurocytosine (5-FC) and amphotericin B (AMPH-B). Two of 38 strains of C. parapsilosis are resistant to flurocytosine (5-FC) showing MIC > or =64 g/mL. There is no resistant strain of fungi (yeast-like organisms) tested against AMPH-B. Six patients from whom resistant fungi were isolated from blood and vascular catheters have severe diseases and/or are have just undergone a major surgical operation. These results indicate that it is vital for deep mycosis to start early treatment with appropriate drugs selected based on rapid detection and identification of organisms and the drug susceptibility of organisms.     

Activity Analyses of Staphylococcal Isolates From Pediatric, Adult, and Elderly Patients: AWARE Ceftaroline Surveillance Program

Ceftaroline, the active metabolite of the prodrug ceftaroline fosamil, is a broad-spectrum cephalosporin with bactericidal activity against resistant Gram-positive organisms, including methicillin-resistant Staphylococcus aureus (MRSA), and common Gram-negative organisms. We evaluated the activity of ceftaroline and various antimicrobial agents against S. aureus isolates according to patient age. A total of 2143 consecutive unique patient strains of clinical significance were collected between January and December 2010 from 65 US medical centers as part of the Assessing Worldwide Antimicrobial Resistance Evaluation (AWARE) Program. Ceftaroline and various comparator agents were tested by reference Clinical and Laboratory Standards Institute broth microdilution methods. Ceftaroline was consistently active against methicillin-susceptible S. aureus (MSSA) (MIC(50), 0.25 μg/mL; MIC(90), 0.25 μg/mL; 100.0% susceptible) and MRSA (MIC(50), 0.50 μg/mL, MIC(90), 1 μg/mL; 98.4% susceptible) from all age groups. In general, resistance rates to erythromycin, clindamycin, and levofloxacin were higher in the population aged ≥65 years, whereas resistance rates to clindamycin and levofloxacin were lowest among isolates from patients aged 6-17 years. When tested against MSSA, levofloxacin resistance was higher among isolates from patients aged ≥65 years (16.1%) than among isolates from the other age groups (6.1%-10.5%), and ceftaroline was generally 16-fold more active than ceftriaxone (MIC(50), 4 μg/mL; MIC(90), 4 μg/mL; 97.9% susceptible overall). Ceftaroline (MIC(50), 0.50 μg/mL; MIC(/90), 1 μg/mL), daptomycin (MIC(50), 0.25 μg/mL; MIC(90), 0.5 μg/mL), linezolid (MIC(50), 1 μg/mL; MIC(90), 1 μg/mL), and vancomycin (MIC(50), 1 μg/mL(;) MIC(90), 1 μg/mL) were the most active compounds tested against MRSA strains, and the activity of these compounds did not vary significantly among the age groups. In contrast, susceptibility rates to clindamycin and levofloxacin varied from 94.0% and 60.7% (aged 6-17 years), respectively, to only 57.6% and 15.1% (aged ≥65 years), respectively, among MRSA strains. The results of this study showed major differences in the susceptibility rates to clindamycin and levofloxacin according to patient age group. The results also indicate that ceftaroline is highly active against MSSA and MRSA isolated from US medical centers, independent of patient age group.     

Effect of Ethiopian multiflora honey on fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients

This study aimed to determine the antifungal effect of Ethiopian multiflora honey against Candida species isolated from the oral cavity of AIDS patients. Oral rinses were obtained from 13 AIDS patients and cultured on CHROMagar plates at 37°C for 48 hours. Candida species were identified by microbiological and molecular techniques. The antifungal effect of the honey sample on Candida was investigated by an agar dilution technique. Susceptibility of the Candida species to fluconazole was tested following a semi-modified microdilution method. Growth of both fluconazole-susceptible and -resistant Candida species was inhibited with a minimum fungicidal concentration (MFC) of 35-40% (v/v) honey. The MFC of different Candida species was not significantly different (P > 0.05). From the total of 25 Candida isolates tested for susceptibility, 11 (44%), eight (32%) and six (24%) of the isolates were sensitive (minimum inhibitory concentrations [MICs] < 8 μg/mL), susceptible (dose-dependent: MICs 16-32 μg/mL) and resistant (MICs > 64 μg/mL) to fluconazole, respectively. Ethiopian multiflora honey has antifungal activity against fluconazole-resistant Candida species isolated from the oral cavity of AIDS patients. This supports the existing folkloric practice of using honey to treat oral lesions. Nevertheless, identification of the bioactive agents in honey, their clinical evaluation and pharmacological standardization are crucial.     

假丝酵母菌感染的临床分布及耐药性分析

目的探讨引起医院感染常见的假丝酵母菌的临床分布及其耐药性特点,为临床抗真菌药物的合理使用提供依据。方法收集我院2008年1月至2010年12月的各种临床标本,进行培养分离纯化,法国梅里埃生物进行真菌的鉴定及药敏试验。结果 3年共分离出假丝酵母菌537株,占前三位分别为白色假丝酵母菌(69.1%)、热带假丝酵母(14.1%)、光滑假丝酵母(7.3%);在临床标本中,痰液分布率最高,占78.8%;感染分布以呼吸内科为主,占31.1%;假丝酵母菌对两性霉素、5-氟胞嘧啶敏感率较高,而对唑类(氟康唑、益曲康唑)药物的耐药率较高。结论真菌感染以白色假丝酵母菌为主,对5种抗真菌药物出现不同程度的耐药,合理使用抗真菌药物,提高临床治疗效果。     

Antifungal susceptibilities of Cryptococcus species complex isolates from AIDS and non-AIDS patients in Southeast China

Cryptococcus spp. are common causes of mycoses in immunocompromised patients. To determine the drug susceptibilities of clinical Cryptococcus spp. isolates, the characteristics of 61 clinical Cryptococcus spp. complex isolates and their antifungal susceptibilities were investigated, including 52 C. neoformans and 9 C. gattii isolates collected at Shanghai between 1993 and 2009. Antifungal susceptibility of clinical isolates to amphotericin B, fluconazole, itraconazole, and flucytosine were determined by the microdilution method M27-A2 and the ATB FUNGUS 3 kit. The 90% minimum inhibitory concentration (MIC90) and susceptibility ranges were as follows: 1 (0.0625-1) μg/mL for amphotericin B, 4 (0.125-16) μg/ mL for fluconazole, 0.25 (0.0313-4) μg/mL for itraconazole, and 4 (0.125-8) μg/mL for flucytosine. Fluconazole, itraconazole, and flucytosine have excellent in vitro activity against all tested clinical Cryptococcus spp., and we also found a high rate of tolerance to amphotericin B (MICs ranging from 0.55-1 μg/mL). Furthermore, C. neoformans isolates from acquired immune deficiency syndrome (AIDS) patients were less susceptible to fluconazole and flucytosine than those from non-AIDS patients. These data suggest that use of amphotericin B may lead to tolerance or resistance of the pathogen over time. There were also no significant associations between species, genotypes, and in vitro susceptibilities of these clinical isolates.     

Erythromycin-resistant group G streptococci in an isolated northern Canadian community

The susceptibility of groups A, C, and G streptococci isolated from pharynx or skin in two northern Canadian native communities during a one year study of the epidemiology of streptococcal infection was determined for penicillin, erythromycin and clindamycin using an agar dilution method. Organisms studied included 725 group A, 82 group C, and 184 group G streptococci. All organisms were susceptible to penicillin (minimum inhibitory concentration [MIC] range less than 0.004 to 0.015 μg/mL; MIC(90) 0.015 μg/mL) and clindamycin (range 0.007 to 0.06 μg/mL; MIC(90) 0.06 μg/mL) with no differences observed between streptococcal groups. For erythromycin, groups A and C were generally susceptible (range less than 0.007 to 0.030 μg/mL; MIC(90) 0.03 μg/mL; and range 0.007 to 1.0 μg/mL; MIC(90) 0.06 μg/mL, respectively). Group G was less susceptible (range 0.007 to greater than 2.0 μg/mL; MIC(90) greater than 2.0 μg/mL) with 38% of all isolates having an MIC greater than or equal to 1 μg/mL. On review of group G isolates, 100 of 100 from one community were susceptible (MIC less than 0.007 to 0.03 μg/mL) and 73 (87%) of 84 from the second community were resistant. All resistant strains tested were type T16. These data suggest that erythromycin-resistant group G streptococci may occur with high prevalence in certain populations and that patterns of antimicrobial susceptibility in isolated communities may be highly community-specific.     

Antimicrobial activity of doripenem against Gram-negative pathogens: results from INVITA-A-DORI Brazilian study

In vitro activity of doripenem and comparator antimicrobial agents was evaluated against Gram-negative bacilli recently isolated from Brazilian private hospitals that were enrolled in the INVITA-A-DORI Brazilian Study. A total of 805 unique Gram-negative bacilli were collected from patients hospitalized at 18 medical centers between May/08 and March/09. Each hospital was asked to submit 50 single Gram-negative bacilli isolated from blood, lower respiratory tract or intraabdominal secretions. Bacterial identification was confirmed and antimicrobial susceptibility testing was performed using Clinical Laboratory Standards Institute (CLSI) microdilution method at a central laboratory. CLSI M100-S21 (2011) or US-FDA package insert criteria (tigecycline) was used for interpretation of the antimicrobial susceptibility results. Doripenem was as active as meropenem and more active than imipenem against E. coli and K. pneumoniae isolates. A total of 50.0% of Enterobacter spp. isolates were resistant to ceftazidime but 85.7% of them were inhibited at doripenem MICs < 1 μg/mL. Polymyxin B was the only agent to show potent activity against Acinetobacter spp. (MIC50/90, < 0.5/1 μg/mL) and P. aeruginosa (MIC50/90, 1/2 μg/mL). Although high rates of imipenem (53.1%) and meropenem (44.5%) resistance were detected among P. aeruginosa, doripenem showed MIC50 of 16 μg/mL against imipenem-resistant P. aeruginosa and inhibited a greater number of imipenem-resistant P. aeruginosa (10.5%) at MIC values of < 4 μg/mL than did meropenem (0.0%). In this study, doripenem showed similar in vitro activity to that of meropenem and retained some activity against imipenem-resistant P. aeruginosa isolated from Brazilian medical centers.     

以棋盘法测定并评价汉防己甲素与酮康唑联合对白念珠菌的体外抗真菌活性

目的 探讨汉防己甲素对酮康唑抗白念珠菌有无增效活性。方法 参照美国临床和实验室标准协会（CLSI）推荐的M27-A3方案,采用棋盘式微量液基稀释法测定汉防己甲素和酮康唑联合对16株同一亲本来源的白念珠菌的体外抗真菌活性。以OD值测定法判读最低抑菌浓度,并以FICI法对联合用药结果进行评价。结果 汉防己甲素与酮康唑单独作用于上述16株白念珠菌的最低抑菌浓度分别为64-128 μg/mL和1-32 μg/mL;两药联合时的最低抑菌浓度值分别降至2-16 μg/mL和0.016-0.5 μg/mL,且终点清晰,“拖尾现象”消失,FICI值为0.033-0.133,均表现为显著协同作用。结论 汉防己甲素在体外对酮康唑抗白念珠菌活性有明显的增效作用。     

Antimicrobial susceptibilities and plasmid patterns of Neisseria gonorrhoeae in Bénin

This study describes antimicrobial susceptibility patterns of Neisseria gonorrhoeae isolates obtained from female sex workers in Cotonou, Bénin. All isolates were susceptible to spectinomycin, ceftriaxone and ciprofloxacin, and susceptible to moderately susceptible to kanamycin; 9.8% of isolates were resistant to thiamphenicol; 9%, 87.5% and 3.5% were susceptible, moderately susceptible, resistant to trimethoprim-sulfamethoxazole, respectively; 94.4% and 99.3% were resistant to penicillin and tetracycline, respectively. All isolates with a minimal inhibitory concentration of tetracycline of >8 mg/l carried the 'American type' tetM plasmid; 94% and 6% of penicillinase-producing isolates possessed a 3.2 MDa and a 4.4MDa beta-lactamase plasmid, respectively. Surveillance of antimicrobial susceptibility of N. gonorrhoeae isolates to currently used drugs in Africa should become part of sexually transmitted diseases (STDs) control programmes.     

Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV-infected and HIV-negative children in northeastern Romania.

OBJECTIVES: The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children. METHODS: Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates. RESULTS: Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 mg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 mg/mL and 8 mg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =/>3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin. CONCLUSIONS: No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.